Min-Jia Cao, Ting-Ting Liang, Li Xu, Fang-Hong Shi
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We calculated odds ratio (OR) or harzard ratio with 95% confidence intervals (CIs) for composite outcomes and dichotomous data, and weighted mean differences (WMD) for changes in eGFR.</p><p><strong>Results: </strong>16 RCTs enrolling 52,306 patients were in the final population, with 26,910 being treated with SGLT2 inhibitors and 25,396 serving as controls were identified. We found that there was no decline in the rate of change in eGFR after 13 weeks and SGLT2 inhibitors treatment significantly improved the rate of change in eGFR after 64 weeks (64-104 weeks: WMD, 1.024 mL/min/1.73m<sup>2</sup>/per year, 95% CI 0.643-1.406; 104 weeks: 0.978, 0.163-1.794).SGLT2 inhibitors reduced the risk of acute kidney injury (AKI) (OR 0.836; 95% CI 0.747-0.936; I<sup>2</sup> = 0%), mainly derived from empagliflozin (P = 0.001) and increased the incidence of volume-related adverse events (AEs) by 23%.However, no statically differences were observed in death due to kidney disease (P = 0.182) or events of eGFR < 15 mL/min/1.73 m<sup>2</sup> (P = 0.202).</p><p><strong>Conclusions: </strong>The results of our meta-analysis showed that after 64 weeks of treatment, SGLT2 inhibitors showed a significant benefit on eGFR rate with no further decline after 13 weeks and the improvement was slighter in lower eGFR values. Additionally, SGLT2 inhibitors reduce AKI when using empagliflozin, while there is an increased risk of volume-related AEs exclusively in stage 2 CKD. 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We selected medical subject heading (MeSH) terms and free text terms associated with gliflozin and RCT. We calculated odds ratio (OR) or harzard ratio with 95% confidence intervals (CIs) for composite outcomes and dichotomous data, and weighted mean differences (WMD) for changes in eGFR.</p><p><strong>Results: </strong>16 RCTs enrolling 52,306 patients were in the final population, with 26,910 being treated with SGLT2 inhibitors and 25,396 serving as controls were identified. We found that there was no decline in the rate of change in eGFR after 13 weeks and SGLT2 inhibitors treatment significantly improved the rate of change in eGFR after 64 weeks (64-104 weeks: WMD, 1.024 mL/min/1.73m<sup>2</sup>/per year, 95% CI 0.643-1.406; 104 weeks: 0.978, 0.163-1.794).SGLT2 inhibitors reduced the risk of acute kidney injury (AKI) (OR 0.836; 95% CI 0.747-0.936; I<sup>2</sup> = 0%), mainly derived from empagliflozin (P = 0.001) and increased the incidence of volume-related adverse events (AEs) by 23%.However, no statically differences were observed in death due to kidney disease (P = 0.182) or events of eGFR < 15 mL/min/1.73 m<sup>2</sup> (P = 0.202).</p><p><strong>Conclusions: </strong>The results of our meta-analysis showed that after 64 weeks of treatment, SGLT2 inhibitors showed a significant benefit on eGFR rate with no further decline after 13 weeks and the improvement was slighter in lower eGFR values. 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引用次数: 0
摘要
背景：我们的荟萃分析通过评估钠-葡萄糖共转运蛋白-2 （SGLT2）抑制剂在慢性肾病（CKD）患者中的肾脏结局，包括长期影响和估计肾小球滤过率（eGFR）值和随访时间的亚组分析，填补了空白。方法：在Medline、Embase和Cochrane Central中检索相关随机对照试验（RCTs）的文献，从开始到2023年6月8日，对SGLT2抑制剂治疗的CKD患者进行研究。我们选择了与格列净和随机对照试验相关的医学主题标题（MeSH）术语和自由文本术语。我们计算了复合结局和二分类数据的95%置信区间（ci）的优势比（OR）或风险比，以及eGFR变化的加权平均差异（WMD）。结果：16项随机对照试验纳入52,306例患者，其中26,910例接受SGLT2抑制剂治疗，25,396例作为对照组。我们发现，13周后eGFR的变化率没有下降，SGLT2抑制剂治疗显著改善了64周后eGFR的变化率(64-104周：WMD， 1.024 mL/min/1.73m2/每年，95% CI 0.643-1.406；104周：0.978,0.163-1.794)。SGLT2抑制剂降低急性肾损伤（AKI）的风险(OR 0.836；95% ci 0.747-0.936；I2 = 0%)，主要来源于恩格列净（P = 0.001），并使容量相关不良事件（ae）的发生率增加了23%。然而，在肾脏疾病导致的死亡（P = 0.182）或eGFR 2事件（P = 0.202）方面没有观察到统计学差异。结论：我们的荟萃分析结果显示，经过64周的治疗，SGLT2抑制剂对eGFR率显示出显著的益处，13周后没有进一步下降，并且在较低的eGFR值中改善轻微。此外，当使用恩格列净时，SGLT2抑制剂可降低AKI，而仅在2期CKD中，容量相关ae的风险增加。试验注册号CRD42023437061。
Evaluating the overall renal outcomes of sodium-glucose cotransporter-2 (SGLT2) inhibitors in patients with chronic kidney disease (CKD).
Background: Our meta-analysis fills gaps by assessing sodium-glucose cotransporter-2 (SGLT2) inhibitors' renal outcomes in chronic kidney disease (CKD) patients including long-term effects and the subgroup analyses of estimated glomerular filtration rate (eGFR) values and follow-up times.
Methods: The literature search of relevant randomized controlled trials (RCTs) was conducted in Medline, Embase, and the Cochrane Central from the inception to 8 June 2023 on patients with CKD treated with SGLT2 inhibitors. We selected medical subject heading (MeSH) terms and free text terms associated with gliflozin and RCT. We calculated odds ratio (OR) or harzard ratio with 95% confidence intervals (CIs) for composite outcomes and dichotomous data, and weighted mean differences (WMD) for changes in eGFR.
Results: 16 RCTs enrolling 52,306 patients were in the final population, with 26,910 being treated with SGLT2 inhibitors and 25,396 serving as controls were identified. We found that there was no decline in the rate of change in eGFR after 13 weeks and SGLT2 inhibitors treatment significantly improved the rate of change in eGFR after 64 weeks (64-104 weeks: WMD, 1.024 mL/min/1.73m2/per year, 95% CI 0.643-1.406; 104 weeks: 0.978, 0.163-1.794).SGLT2 inhibitors reduced the risk of acute kidney injury (AKI) (OR 0.836; 95% CI 0.747-0.936; I2 = 0%), mainly derived from empagliflozin (P = 0.001) and increased the incidence of volume-related adverse events (AEs) by 23%.However, no statically differences were observed in death due to kidney disease (P = 0.182) or events of eGFR < 15 mL/min/1.73 m2 (P = 0.202).
Conclusions: The results of our meta-analysis showed that after 64 weeks of treatment, SGLT2 inhibitors showed a significant benefit on eGFR rate with no further decline after 13 weeks and the improvement was slighter in lower eGFR values. Additionally, SGLT2 inhibitors reduce AKI when using empagliflozin, while there is an increased risk of volume-related AEs exclusively in stage 2 CKD. Trial registration CRD42023437061.
期刊介绍：
Diabetology & Metabolic Syndrome publishes articles on all aspects of the pathophysiology of diabetes and metabolic syndrome.
By publishing original material exploring any area of laboratory, animal or clinical research into diabetes and metabolic syndrome, the journal offers a high-visibility forum for new insights and discussions into the issues of importance to the relevant community.
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